Perspectives on repeated low-level blast and the measurement of neurotrauma in humans as an occupational exposure risk

A pressing question in military medical research is the nature and degree of effects on the human brain from occupational repeated exposure to low-level explosive blast, but reliable and effective means to objectively measure such effects remain elusive. In survey results, headache, difficulty sleeping, irritability, cognitive impairment, and a variety of other symptoms consistent with post-concussive syndrome have been reported by those exposed to blast and there was positive correlation between degree of blast exposure and degree of symptomology, but an important goal is to obtain more objective evidence of an effect than self-report alone. This review reflects recent efforts to measure and evaluate such hypothesized effects and current recommendations for ongoing study. Optimal measures are likely those with sensitivity and specificity to systemic effects in mild neurotrauma, that have minimal to no volitional component, and that can be sampled relatively quickly with minimal intrusion in prospective, observational field studies during routine training with explosives. An understanding of an association between parameters of exposure to repeated low-level blast and negative neurologic effects would support the evaluation of clinical implications and development of protective equipment and surveillance protocols where warranted. At present, low-level blast exposure surveillance measurements do not exist as a systematic record for any professional community.